Cow’s Milk Proteın Allergy

Yıl 2017, Cilt: 9 Sayı: 2, 78 - 88, 15.03.2017

Dr. Can Naci Kocabaş

Öz

Abstract

The reactions that occur as a result of immunological mechanisms against proteins in cow’s milk are called cow’s milk protein allergy (CMPA). The underly ingimmune response can be immunoglobulin-E (IgE) mediated, non-IgE mediated oras a combination of both. In small children, the most frequent food allergy is CMPA(2-3%). About 50-70% of the patients have cutaneous symptoms, while 50-60% havegastrointestinal symptoms and 20-30% have respiratory symptoms. While IgE mediated reactions are seen within the first two hours, non-IgE mediated reactions oc-cur in 2 hours and later. In patients identified with the reaction, first detailed diet history should be taken and physical examination should be performed. Skin prick testsand specific IgE measurement are among frequently used allergy tests. Patch testsare preferred especially in non-IgE mediated reactions. However, the golden standard test in diagnosis is “double blind placebo controlled food challenge tests”. Inthe last years, the number of studies about “component resolved diagnosis” method has been increasing. Elimination diets form the basis oftreatment. In a great majority of the patients, tolerance hasbeen known to develop before the age of five.

Anahtar Kelimeler

Food allergy, cow’s milk protein allergy, componentresolved diagnosis, treatment, prognosis

İnek Sütü Protein Alerjisi

Öz

Öz

İnek sütünde bulunan proteinlere karşı immünolojik mekanizmalarla oluşan reaksiyonlara inek sütü protein alerjisi (İSPA) denir. Altta yatan immün cevap immünglobülin-E (IgE) aracılı, IgE den bağımsız (non-IgE) veya her ikisinin birleşimi şeklinde olabilir. Küçük çocuklarda tüm besin alerjileri içerisinde en sık İSPA (%2-3) görülmektedir. Hastaların yaklaşık %50-70’inde kütanöz, %50-60’ında gastrointestinal ve %20-30’unda solunum semptomları görülür. IgE aracılı reaksiyonlar ilk 2 saat içerisinde görülürken, non-IgE aracılı reaksiyonlar 2 saat ve sonrasında ortaya çıkar. Reaksiyon tariflenen hastalarda öncelikle detaylı beslenme öyküsü alınmalı vefizik muayene yapılmalıdır. Sıklıkla kullanılan alerji testleri arasında deri prick testleri ve spesifik IgE ölçümü yer alır. Yama testleri özellikle non-IgE aracılı reaksiyonlarda tercih edilir. Ancak tanıda altın standart test “çift kör plasebo kontrollü besin provokasyon testleri”dir. Son yıllarda “bileşene dayalı tanı” yöntemi ile ilgili çalışmaların sayısı artmaktadır. Tedavinin temelini eliminasyon diyetleri oluşturur. Hastaların büyük çoğunluğunda 5 yaşından önce tolerans geliştiği bilinmektedir.

Anahtar Kelimeler

Besin alerjisi, inek sütü proteinalerjisi, bileşene dayalı tanı, tedavi, prognoz

Kaynakça

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Kaya A, Toyran M, Civelek E, Misirlioglu E, Kirsaclioglu C,Kocabas CN. Characteristics and Prognosis of AllergicProctocolitis in Infants. J Pediatr Gastroenterol Nutr.2015;61:69-73. 16. Nowak-Wegrzyn A, Burks AW, Sampson HA. Reactions to Fo-ods. In: Adkinson NF Jr, et al. eds. Middleton’s Allergy: Prin-ciples and Practice. 8thed. Vol. 2. Philadelphia: Saunders Els-evier Inc; 2014. p.1310-39. 5. 17. Host A, Halken S. Cow's milk allergy: where have we comefrom and where are we going? Endocr Metab Immune DisordDrug Targets. 2014;14:2-8 18. Pumphrey RS, Gowland MH. Further fatal allergic reactionsto food in the United Kingdom, 1999-2006. J Allergy Clin Im-munol 2007;119:1018-1019. 19. Sharma HP, Bansil S, Uygungil B. Signs and Symptoms of FoodAllergy and Food-Induced Anaphylaxis. Pediatr Clin N Am.2015;62:1377–1392 20. Burks AW, Jones SM, Boyce JA, Sicherer SH, Wood RA, As-sa’ad A, et al. NIAID-sponsored 2010 guidelines for mana-ging food allergy: applications in the pediatric population. Pe-diatrics 2011;128:955-65. 21. Caubet JC, Ford LS, Sickles L, Jarvinen KM, Sicherer SH,Sampson HA, et al. Clinical features and resolution of foodprotein-induced enterocolitis syndrome: 10-year experience.J Allergy Clin Immunol 2014;134:382-9. 22. Katz Y, Goldberg MR, Rajuan N, Cohen A, Leshno M. Theprevalence and natural course of food protein-induced en-terocolitis syndrome to cow's milk: a large-scale, prospec-tive population-based study. J Allergy Clin Immunol2011;127:647-53 e1-3. 23. Lake AM, Whitington PF, Hamilton SR. Dietary protein-in-duced colitis in breastfed infants. J Pediatr 1982;101:906-10 24. Kuitunen P, Visakorpi JK, Savilahti E, Pelkonen P. Malabsorp-tion syndrome with cow’s milk intolerance. Clinical findings andcourse in 54 cases. Arch Dis Child 1975;50:351-6. 25. Furuta GT, Liacouras CA, Collins MH, et al. Eosinophilic esop-hagitis in children and adults: a systematic review and con-sensus recommendations for diagnosis and treatment. Gastro-enterology 2007;133:1342–63 26. Burks W. Skin manifestations of food allergy. Pediatrics2003;111(6 Pt 3):1617-1624. 27. Irvine AD, McLean WH, Leung DY. Filaggrin mutations as-sociated with skin and allergic diseases. N Engl J Med2011;365:1315-1327. 28. Hanifin JM, Rajka G. Diagnostic features of atopic derma-titis. Acta Derm Venereol (Stockh) 1980; 92(Suppl):44-7 29. du Toit G, Meyer R, Shah N, Heine RG, Thomson MA, LackG, Fox AT. Identifying and managing cow’smilk protein al-lergy. Arch Dis Child Educ Pract Ed 2010;95:134–144. 30. Soares-Weiser K , Takwoingi Y , Panesar SS , Muraro A , Wer-fel T , Hoffmann-Sommergruber K et al. The diagnosis of foodallergy: a systematic review and meta-analysis. Allergy2014;69.76–86 31.Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G,Beyer K, Bindslev-Jensen C, et al.; EAACI Food Allergy andAnaphylaxis Guidelines Group. EAACI food allergy andanaphylaxis guidelines: diagnosis and management of foodallergy. Allergy 2014;69:1008-25. 32. Martorell-Aragonésa A, Echeverría-Zudaireb L, Alonso-Leb-reroc E, Boné-Calvod J, Martín-Munoz ˜e MF, Nevot-Fal-cóf S et all , Food allergy committee of SEICAP (Spanish So-ciety of Pediatric Allergy, Asthma and Clinical Immunolog).Po-sition document: IgE-mediated cow’s milk allergy. AllergolImmunopathol (Madr). 2015;43:507-526. 33. Ford LS, Bloom KA, Nowak-Wegrzyn AH, Shreffler WG, Ma-silamani M, Sampson HA. Basophil reactivity, wheal size, andimmunoglobulin levels distinguish degrees of cow's milk to-lerance J Allergy Clin Immunol. 2013;13:180-186 34. Canonica GW, Ansotegui IJ, Pawankar R, Schmid-Grendel-meier P, van Hage M, Baena-Cagnani CE et al. A WAO-ARIA-GA²LEN consensus document on molecular-based allergy di-agnostics. World Allergy Organ J. 2013;6:17. 35. Caubet JC, Nowak-Wegrzyn A, Moshier E, Godbold J,Wang J, Sampson HA. Utility of casein-specific IgE levels inpredicting reactivity to baked milk. J Allergy Clin Immunol2013;131:222-4.e1-4 36. Koletzko S, Niggemann B, Arato A, et al. European Society ofPediatric Gastroenterology, Hepatology, and Nutrition. Diag-nostic approach and management of cow’s-milk protein allergyin infants and children: ESPGHAN GI Committee practical gui-delines. J Pediatr Gastroenterol Nutr 2012; 55: 221-229. 37. Kattan JD, Cocco RR, Jarvinen KM. Milk and soy allergy. Pe-diatr Clin North Am. 2011;58:407-26. 38. American Academy of Pediatrics. American Academy of Pe-diatrics: Committee on Nutrition. Hypoallergenic infant for-mulas. Pediatrics. 2000;106:346-9. 39. Boissieu D, Dupont C. Allergy to extensively hydrolyzed cow’smilk proteins in infants:safety and duration of amino acid-ba-sed Formula. J Pediatr2002;141:271-3 40. Şekerel BE. In: Şekerel BE (ed). İnek Sütü Protein Allerjisin-de Rasyonel Formula Kullanımı. (1.Baskı). Ankara: AnkamatMatbaacılık. 2016, 51-59. 41. Güvenir HA. Büyüktiryaki AB. Besin Alerjilerinin Uzun Sü-reli Tedavisi (Long Term Treatment of Food Allergy). Turki-ye Klinikleri J Pediatr Sci 2016;12:56-65. 42. Keet CA, Frischmeyer-Guerrerio PA, Thyagarajan A, et al.The safety and efficacy of sublingual and oral immunotherapyfor milk allergy. J Allergy Clin Immunol 2012; 129:448. 43. Çapanoğlu M, Büyüktiryaki AB. Non-IgE aracılı Besin Aler-jileri (Non-IgE mediated Food Allergy). Turkiye Klinikleri JPediatr Sci 2016;12:35-44 44. Kaya A, Toyran M, Civelek E, Misirlioglu E, Kirsaclioglu C,Kocabas CN. Characteristics and Prognosis of AllergicProctocolitis in Infants. J Pediatr Gastroenterol Nutr.2015;61:69-73.